Healthcare Provider Details

I. General information

NPI: 1548689276
Provider Name (Legal Business Name): KELLEY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N SALEM ST STE 201-K
APEX NC
27502-1564
US

IV. Provider business mailing address

122 N SALEM ST STE 201-K
APEX NC
27502-1564
US

V. Phone/Fax

Practice location:
  • Phone: 919-249-5423
  • Fax:
Mailing address:
  • Phone: 919-249-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7483
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7483
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNC LPC BOARD

VIII. Authorized Official

Name: AMELIA KELLEY
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 919-249-5423